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Normal electrocardiogram (ECG) readings in heart attack patients should not be dismissed as problem-free, according to Wayne State University researchers in a study published in the October 24/31 issue of the Journal of the American Medical Association. Unexpectedly high death rates were found in a study of hospitalized heart attack patients with normal ECGs.

Robert Welch, MD, assistant professor of emergency medicine, was the lead author on the study, “Prognostic Value of a Normal or Nonspecific Initial Electrocardiogram in Acute Myocardial Infarction (AMI).” He and his colleagues analyzed data on patients with AMI who had normal or nonspecific ECGs, and those who had ECGs resulting in a diagnosis of heart attack, to determine the predictive value of the initial ECG for in-hospital mortality.

“The unexpected finding of this study was that patients with an initially normal ECG had a substantial mortality rate, one that approximates the 30-day risk for patients with ST-segment elevation treated in recent trials of reperfusion therapies. Our results demonstrate that, for patients with AMI, a normal or nonspecific initial ECG does not always indicate that the patient will have a favorable hospital course,” the researchers said.

Normal ECG
Normal ECGs could still require attention, according to WSU researchers who published an article in JAMA.

The authors of the study were correct in predicting that patients with normal ECGs would have better short-term survival rates than those with abnormal readings. However, nearly 6 percent of the people with normal ECGs died. That number is triple the rate researchers expected based on previous studies.

More than 5.3 million patients sought emergency care for chest pain or related symptoms in 1998. These findings have implications for the approximately 2 to 4 percent of patients with AMI who are inadvertently discharged from the emergency department, assuming a favorable prognosis.

“The initial ECG is the first and most effective tool used for riskstratification of patients with symptoms suggestive of AMI,” researchers said. “It is, therefore, important to understand its prognostic value and to be aware of the actual and absolute risks for those patients.”

Co-authors on the study include Drs. Robert J. Zalenski, Scott Compton, Mary Sue Grzybowski, Sophia Thomas and Terry Kowalenko.

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